Mid-Atlantic Stone Center ("Center") is pleased to provide you with the following information regarding Shockwave Lithotripsy ("SWL") treatment at the Center, in accordance with the New Jersey Out of Network Consumer Protection, Transparency, Cost Containment and Accountability Act. The Center provides services only to patients whose physicians have arranged for them to have SWL at the Center.

Direct Government Plans. All Center services for patients who are insured under Medicare, Medicaid, Tri-Care or other direct government insurance plans are provided at the Center under arrangement with Virtua Health, 90 Brick Road, Marlton, NJ 08053. Patients insured under direct government insurance plans should call their plan contact for information related to charges for SWL treatment provided at the Center.

Globally-Billed Plans. The Center is a participating in-network provider with the health benefits plans set forth below:

The Center bills the above-listed plans on a global basis, meaning that the charges billed by the Center will include all charges for facility services, technical services, professional physician services and anesthesia services. Patients covered by the above-listed plans should contact their insurance carrier for further consultation on coverage and the charges (including copayment, deductible and coinsurance amounts) for such services.

Separate Billing for Certain Services under United Healthcare Plans. The Center is a participating in-network provider with United Healthcare and United Healthcare UMR plans, as well as the United Healthcare Community Plan; however, the Center does not bill those plans on a global basis. The Center will bill the United Healthcare and United Healthcare UMR plans for all facility, technical and anesthesia services related to the patient’s SWL treatment at the Center. The Center will bill the United Healthcare Community Planonly for the facility and technical services related to the patient’s SWL treatment at the Center. With respect to all United Healthcare, United Healthcare UMR and United Healthcare Community plans, professional physician services provided at the Center will not be included in the Center’s charges.

The physicians who provide professional SWL services at the Center may or may not participate in United Healthcare, United Healthcare UMR and/or United Healthcare Community plans. Also, the anesthesiologists who provide anesthesia services at the Center may or may not participate in the United Healthcare Community Plan.

Patients should contact (see contact information below) the physician arranging for services at the Center to determine if such physician participates in the patient’s United Healthcare, United Healthcare UMR or United Healthcare Community plan.

Patients covered by United Healthcare, United Healthcare UMR or United Healthcare Community plans should contact their insurance carrier for further consultation on coverage and the charges (including copayment, deductible and coinsurance amounts) for any of the services provided at the Center (including the facility, technical, professional physician and anesthesia services).

Plans with which the Center is Out-of-Network. The Center is out-of-network with all health benefits plans other than those set forth in Paragraphs 2 and 3 above (including, but not limited to, all self-funded health benefits plans). Patients should contact their insurance carrier for further consultation on coverage and the charges (including copayment, deductible and coinsurance amounts) for all of the services provided at the Center (including the facility, technical, professional physician and anesthesia services).

Contact Information for Physicians. Please see the Credentialed Physicians tab on the Center's website at http://www.midatlanticstonecenter.com for the name, mailing address and telephone numbers of the physicians who provide professional SWL services at the Center.

Contact Information for Anesthesiologists. All anesthesiology services at the Center are provided by: